“The asylum is up on the hill, but the lunatics are all over the State.” So remarked James Petigru, an antebellum Unionist, when he heard of South Carolina's plans to secede from the United States. Petigru was obviously referring to insanity in political terms, but he inadvertently made an important point about insanity as a psychiatric condition. In contrast to what one might deduce from standard histories of mental illness in the 19th century, much of the care of the insane occurred not in asylums but in the community.

Lerner BH. Reviews and Notes: History of Medicine: Moonlight, Magnolias, and Madness: Insanity in South Carolina from the Colonial Period to the Progressive Era. Ann Intern Med. 1996;125:784. doi: 10.7326/0003-4819-125-9-199611010-00035